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Nart L, Desikan M, Pietrusz A, Savvatis K, Quinlivan R. Neurodiversity, treatment compliance and survival in adults with Duchenne muscular dystrophy: a single-centre retrospective cohort review. Neuromuscul Disord 2024; 35:13-18. [PMID: 38194731 DOI: 10.1016/j.nmd.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/24/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024]
Abstract
Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy worldwide. With increasing survival, there is now a greater awareness of associated neurodevelopmental co-morbidities. Despite this, there is currently a limited understanding of how these co-morbidities might potentially impact on health outcomes. This study reviewed the characteristics of 37 adults with DMD who died between 2011 and 2022. The median age of death was 22.25 years, and those with neurodevelopmental co-morbidities had statistically poorer survival than those without a neurodevelopmental disorder. Notably, the proportion of patients within this cohort with a diagnosis of a neurodevelopmental disorder was higher than previously reported studies in living cohorts. This study suggests that patients with a co-morbid neurodevelopmental disorder may have worse health outcomes than those who do not.
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Affiliation(s)
- Luca Nart
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
| | - Mahalekshmi Desikan
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Aleksandra Pietrusz
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Konstantinos Savvatis
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; Barts Heart Centre, Saint Bartholomew's Hospital, London, United Kingdom
| | - Ros Quinlivan
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
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Ward JH, Weir E, Allison C, Baron-Cohen S. Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults. Mol Autism 2023; 14:35. [PMID: 37730651 PMCID: PMC10510241 DOI: 10.1186/s13229-023-00565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. METHOD We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini-Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. RESULTS There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac's disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. LIMITATIONS Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. CONCLUSIONS This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac's disease and EDS.
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Affiliation(s)
- John H Ward
- Royal Devon University NHS Foundation Trust, Exeter, Devon, UK
- University of Exeter Medical School, Devon, UK
- University of Oxford, Department of Psychiatry, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Elizabeth Weir
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK.
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK
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Ellis R, Williams K, Brown A, Healer E, Grant A. A realist review of health passports for Autistic adults. PLoS One 2023; 18:e0279214. [PMID: 37682898 PMCID: PMC10490970 DOI: 10.1371/journal.pone.0279214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs. METHODS We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool. FINDINGS 162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact. CONCLUSION There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes.
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Affiliation(s)
- Rebecca Ellis
- Centre for Lactation Infant Feeding and Translation (LIFT), Swansea University, Swansea, United Kingdom
| | - Kathryn Williams
- Autistic UK CIC, Llandudno, Wales, United Kingdom
- School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Amy Brown
- Centre for Lactation Infant Feeding and Translation (LIFT), Swansea University, Swansea, United Kingdom
| | - Eleanor Healer
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
| | - Aimee Grant
- Centre for Lactation Infant Feeding and Translation (LIFT), Swansea University, Swansea, United Kingdom
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Sheehan R, Mansour H, Broadbent M, Hassiotis A, Mueller C, Stewart R, Strydom A, Sommerlad A. Recording of intellectual disability in general hospitals in England 2006-2019: Cohort study using linked datasets. PLoS Med 2023; 20:e1004117. [PMID: 36940198 PMCID: PMC10069786 DOI: 10.1371/journal.pmed.1004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/03/2023] [Accepted: 02/20/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Accurate recognition and recording of intellectual disability in those who are admitted to general hospitals is necessary for making reasonable adjustments, ensuring equitable access, and monitoring quality of care. In this study, we determined the rate of recording of intellectual disability in those with the condition who were admitted to hospital and factors associated with the condition being unrecorded. METHODS AND FINDINGS Retrospective cohort study using 2 linked datasets of routinely collected clinical data in England. We identified adults with diagnosed intellectual disability in a large secondary mental healthcare database and used general hospital records to investigate recording of intellectual disability when people were admitted to general hospitals between 2006 and 2019. Trends over time and factors associated with intellectual disability being unrecorded were investigated. We obtained data on 2,477 adults with intellectual disability who were admitted to a general hospital in England at least once during the study period (total number of admissions = 27,314; median number of admissions = 5). People with intellectual disability were accurately recorded as having the condition during 2.9% (95% CI 2.7% to 3.1%) of their admissions. Broadening the criteria to include a nonspecific code of learning difficulty increased recording to 27.7% (95% CI 27.2% to 28.3%) of all admissions. In analyses adjusted for age, sex, ethnicity, and socioeconomic deprivation, having a mild intellectual disability and being married were associated with increased odds of the intellectual disability being unrecorded in hospital records. We had no measure of quality of hospital care received and could not relate this to the presence or absence of a record of intellectual disability in the patient record. CONCLUSIONS Recognition and recording of intellectual disability in adults admitted to English general hospitals needs to be improved. Staff awareness training, screening at the point of admission, and data sharing between health and social care services could improve care for people with intellectual disability.
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Affiliation(s)
- Rory Sheehan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Hassan Mansour
- Division of Psychiatry, University College London, London, United Kingdom
| | - Matthew Broadbent
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andre Strydom
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, United Kingdom
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Development of a Novel Multi-Disciplinary Specialized Care Service for Children and Adolescents with Autism Spectrum Disorder and/or Intellectual/Developmental Disability in a Tertiary Children's Hospital Setting. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010057. [PMID: 36670608 PMCID: PMC9856852 DOI: 10.3390/children10010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Abstract
Children and adolescents with autism spectrum disorder (ASD) and/or Intellectual/Developmental Disability (IDD) are at greater risk of developing comorbid medical conditions, mental health diagnoses, behavioral challenges, and having overall poorer physical and mental health outcomes. Hospital environments present unique stressors and challenges for children and adolescents with ASD/IDD including a change in familiar environment, unpredictable routines, and exposure to sensory stimuli that may be overwhelming. While many school boards have specialized multi-disciplinary special needs support teams and services made up of professionals with expertise in supporting students with ASD/IDD, most hospitals do not have a formal multi-disciplinary ASD/IDD support team in place to support patients, families, and health care staff across the hospital. There is an emerging recognition of the need for specialized multi-disciplinary developmental-behavioral and mental health expertise in hospital inpatient settings. This paper describes the framework for the development of an innovative multi-disciplinary program to better support children and adolescents with ASD/IDD within a tertiary children's hospital setting.
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Featherstone C, Sharpe RA, Axford N, Asthana S, Husk K. Health and wellbeing outcomes and social prescribing pathways in community-based support for autistic adults: A systematic mapping review of reviews. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e621-e635. [PMID: 34738679 DOI: 10.1111/hsc.13635] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
Adults on the autism spectrum are affected by health disparities which significantly reduce life expectancy and experience barriers to accessing healthcare. Social prescribing is a holistic approach that diverts patients from primary care to health-enhancing activities in communities. However, there has been a lack of research attention to how autistic people navigate the social prescribing pathway and the ability of these approaches to address existing disparities. This mapping review aimed to synthesise features of non-medical, community-based interventions for autistic adults to assess their suitability for a social prescribing approach. A systematic search and screening process was used to identify literature reviews from medical databases (Embase, Medline, PsycINFO, CINAHL and Cochrane reviews) and grey literature. We extracted data from 24 reviews and 19 studies including types of services, participants, outcomes, settings and procedures. A narrative and visual synthesis is used to map the variety of services and interventions identified, the outcome measures used, and the barriers and facilitators to progression through services in relation to a realist social prescribing framework. The review found that there has been minimal evaluation of holistic, low intensity services for autistic adults, such as those offered in social prescribing approaches. Outcome measures remain focused on features of autism and reveal less about the effects of interventions on health and wellbeing. Aspects of the social prescribing model were identified in the features of service pathways, but findings also suggested how social prescribing could be adapted to improve accessibility for autistic people.
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Affiliation(s)
- Charlotte Featherstone
- NIHR Applied Research Collaboration (ARC) South West Peninsula, University of Plymouth, Plymouth, UK
| | - Richard A Sharpe
- Public Health, Cornwall Council and European Centre for Environment and Human Health, University of Exeter Medical School, Royal Cornwall Hospital, Truro, UK
| | - Nick Axford
- NIHR Applied Research Collaboration (ARC) South West Peninsula, University of Plymouth, Plymouth, UK
| | - Sheena Asthana
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Kerryn Husk
- NIHR Applied Research Collaboration (ARC) South West Peninsula, University of Plymouth, Plymouth, UK
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Erwin J, Paisi M, Witton R, Neill S, Burns L, Vassallo I, Nelder A, Facenfield J, Devalia U, Vassallo T. Factors Influencing Oral Health Behaviours, Access and Provision of Dental Care for Autistic Children and Adolescents in Countries with a Very High Human Development Index: Protocol for a Mixed Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312346. [PMID: 34886072 PMCID: PMC8657110 DOI: 10.3390/ijerph182312346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
Autistic children and adolescents are at high risk of dental disease and experience oral health inequalities. They consistently show high levels of unmet needs in relation to their oral health and access to dental care. There are no systematic reviews that bring together the evidence on the factors that influence oral hygiene behaviours, and access to and provision of dental care for autistic children and adolescents. A systematic search will be carried out in eight international databases and in grey literature of qualitative, quantitative and mixed method research studies from countries with a High Development Index which relate to oral health behaviours, and access to and provision of dental care. Only studies where participants are autistic children and adolescents aged 19 years or under, parents/guardians/caregivers, support staff, or oral health care providers will be included. Quantitative and qualitative data will be synthesized together through data transformation using a convergent integrated approach. Thematic synthesis will be used to carry out an inductive analysis of the data. The findings from the systematic review which this protocol generates will be used in the development of an appropriate local clinic care pathway for autistic children/adolescents and to inform national policies and practices. Prospero registration: CRD 42021248764.
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Affiliation(s)
- Jo Erwin
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- Correspondence:
| | - Martha Paisi
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Robert Witton
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Sarah Neill
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
| | - Isaac Vassallo
- School of Engineering, Computing and Mathematics, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
| | - Abigail Nelder
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Jemma Facenfield
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Urshla Devalia
- Royal National ENT and Eastman Dental Hospital, London University, 47-49 Huntley St, London WC1E 6DG, UK;
| | - Tara Vassallo
- Plymouth Institute of Education, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
- National Autistic Society—Plymouth & District Branch, Plymouth PL1 4QU, UK
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